Induction therapy in renal transplantation

Polyclonal antibodies such as antithymocyte globulin and monoclonal antibodies such as OKT3 are widely used in clinical transplantation to improve long-term allograft survival by delaying the first episodes of acute rejection, to circumvent cyclosporine and tacrolimus-induced nephrotoxicity, and to treat acute rejection. In some centers, treatment with antithymocyte globulin or OKT3 is started at the time of grafting as induction therapy. In other centers, their use is limited to patients with preformed cytotoxic antibodies, second grafts, delayed graft function, prolonged cold ischemia time, or steroid-resistant rejection episodes. Newer polyclonal antibodies such as rabbit antithymocyte globulin (ATG) and monoclonal antibodies against interleukin-2α receptors such as Daclizumab (Roche, Inc., Nutley, NJ) and basiliximab were also approved to prevent acute rejection and improve graft function. The effect of monoclonal antibodies against adhesion molecules such as anti–intercellular adhesion molecule 1, and antileukocyte function-associated antigen 1 in the clinical transplantation is not clear and needs further investigation.